Hybrid transthoracic oesophagectomy due to carcinoma with complications after COVID-19 pneumonia - A case report.

INTRODUCTION AND IMPORTANCE: This case report describes postoperative complications in a patient after hybrid oesophagectomy for oesophageal carcinoma after COVID pneumonia. The global COVID-19 pandemic affected cancer patients indicated for surgery. Covid 19 may worsen the results of oesophageal cancer surgery. More similar studies are needed. CASE PRESENTATION: A 69-year-old male was diagnosed with squamous cell carcinoma of the middle oesophagus based on PET/CT without disease generalisation. His stenotic tumour required a nutritive jejunostomy, with subsequent neoadjuvant radiochemotherapy indicated according to the CROSS protocol. The patient developed COVID pneumonia during the cancer therapy. After managing the COVID pneumonia, oncological therapy was completed and a hybrid oesophagectomy was performed 8 weeks later. Serious complications (respiratory failure, septic shock, anastomosis dehiscence) developed during the postoperative period. All complications were managed therapeutically. The patient was type IVb according to the Clavien-Dindo classification. CLINICAL DISCUSSION: Postoperative complications may develop in any patient operated for oesophageal carcinoma, especially if high-risk predictive factors are present. The question arises as to how much the post-COVID condition affected the onset of these serious complications. CONCLUSION: Post-COVID patients are at a risk of developing post-COVID syndrome, which may lead to a wide range of symptoms in the affected organs. Further studies on the relationship between COVID-19 and oesophagectomy for oesophageal carcinoma will be necessary to clarify the relationship between the complications during the postoperative period in patients with oesophageal malignancy.

[Bacterial complications in surgical management of esophageal cancer].

One of the most common cancers is esophageal carcinoma. The basic therapeutic approach is esophagectomy, one of the most extensive procedures in general surgery, potentially leading to serious postoperative complications, in particular respiratory complications. The objective was clinical and microbiological characterization of patients after the surgical removal of the esophagus for carcinoma. In 2020, a total of 14 patients underwent the surgery. Respiratory complications occurred in 57 % of them, with pneumonia leading to respiratory failure and acute respiratory distress syndrome being noted in 21 %. The identified bacterial pathogens were strains of Acinetobacter johnsonii, Enterobacter cloacae, Serratia marcescens, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Enterococcus faecium. In one case, the patient's condition was complicated by fungal infection caused by Candida krusei. The study results warrant the need for close collaboration between the physician caring for a particular patient and a microbiologist that must be continuous and based on daily assessment of both microbiology test results and the patient's clinical condition.

Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract.

AIM: The aim of this study was to reduce the severe respiratory complications of esophageal cancer surgery often leading to death. METHODS: Two groups of patients operated on for esophageal cancer were evaluated in this retrospective analysis. The first group was operated between 2006-2011, prior to the implementation of preoperative microbiological examination while the second group had surgery between 2012-2017 after implementation of this examination. RESULTS: In total, 260 patients, 220 males and 40 females underwent esophagectomy. Between 2006-2011, 113 (87.6%) males and 16 (12.4%) females and between 2012-2017, esophagectomy was performed in 107 (81.7%) males and 24 (18.3%) females. In the first cohort, 10 patients died due to respiratory complications. The 30-day mortality was 6.9% and 90-day was 9.3%. In the second cohort, 4 patients died from respiratory complications. The 30-day mortality was 1.5% and 90-day mortality was 3.1%. With regard to the incidence of respiratory complications (P=0.014), these occurred more frequently in patients with sputum collection, however, severe respiratory complications were more often observed in patients without sputum collection. Significantly fewer patients died (P=0.036) in the group with sputum collection. The incidence of respiratory complications was very significantly higher in the patients who died (P<0.0001). CONCLUSION: The incidence of severe respiratory complications (causing death) may be reduced by identifying clinically silent respiratory tract infections.

Individualized Prophylaxis in Patients with Esophageal Replacement Because of Cancer.

BACKGROUND: Presented are the findings from an analysis of respiratory inflammatory complications in patients undergoing esophageal replacement because of cancer. Respiratory complications are manifested most frequently within five post-operative days, thus, they are likely to be caused by potentially pathogenic micro-organisms originating from the primary or secondary microflora. METHODS: Sputum samples were collected 1-2 wks pre-operatively. In cases of positive microbiologic finding of some potential pathogens, individualized antibiotic prophylaxis was designed. RESULTS: Patients with individualized prophylaxis had fewer respiratory complications (10%) than patients with general antibiotic prophylaxis (41%). CONCLUSIONS: The approach to pre-operative sputum tests should be changed. If culture results are positive for bacteria with high resistance to antimicrobial agents or yeasts, the so-called individualized prophylaxis based on these particular results should be used.

Assessment of renal graft function depending on pre-transplant morphology.

BACKGROUND: Histopathological assessment of kidney prior to transplantation is a part of the comprehensive information gathered on the transplanted organ. In our study we monitor the influence of individual morphological findings (glomeruli, arteries, arterioles, interstitium, tubules) and degree of histopathological changes in the kidney function after transplantation. METHODS: From 1994 to 1997, 117 cadaveric kidneys were histopathologically examined and subsequently transplanted. Biopsy in a form of wedge excision was obtained during the organ procurement after in situ kidney perfusion and its removal from donor's body. Evaluated were glomerulosclerosis, intimal fibrosis of arteries, arteriolar hyalinization, interstitial fibrosis and tubular changes (vacuolar dystrophy of tubular epithelium, desquamation of tubular epithelium, brush border of proximal tubules, tubular dilatation, haemoglobin cylinders in distal tubules). Kidney recipients were monitored both for immediate function of transplanted organ and long-term kidney function for a period of five years following. RESULTS: In our group of patients, no unambiguously negative influence of histopathological change in individual morphologies was found either in the immediate or in the long-term function of the transplanted kidney. CONCLUSION: It is possible to transplant kidneys and attain satisfactory results even with these types of histopathological changes: glomerulosclerosis greater or equal to 20 %, mild degree of arterial lesion, moderate arteriolar lesions, moderate lesions of interstitial fibrosis and tubular lesions. The degree of arterial lesions, arteriolar lesions and the degree of interstitial fibrosis closely correlate to the donor's age, hypertension and nontraumatic cerebrovascular accident as the cause of death. Same outcomes were also confirmed with glomerulosclerosis, with the exception of the influence of the donor's age.

Femoral - internal iliac bypass in aortoiliac aneurysms endovascular repair.

The authors describe femoral - internal iliac bypass creation to remove ischemic complications in aortoiliac aneurysm endovascular repair. Based on a good experience with bypass in 6 patients they recommend its preventive indication when both internal iliac arteries are overstented.

Effect of various protective solutions on function after kidney transplantation.

UNLABELLED: From 1995 to 2002 we monitored a group of 127 patients who had undergone kidney transplantations in the Olomouc transplantation centre. The aim of our study was to assess the function of the kidneys after the transplantation, which were rinsed during the removal from cadaverous donors and afterwards were treated by different preservative dilutions. We divided the patients into three groups of approximate similar size, according to the used dilution - EC (Eurocollins), HTK (Custodiol) and UW (Viaspan). In the first three weeks we assessed in each group, the immediate function of the kidneys as primary, belated and afunction. The EC group showed the primary function in 51.2 % of cases, belated in 46.8 % of cases and afunction in 2.1 % of cases. In the HTK group, primary function was found in 73.7 %, belated 23.6 % and afunction 2.7 %. The results of the UW group came to primary function 71.5 %, belated 26.2 % and afunction 2.3 %. The criteria of the immediate but also the long-term function (five year investigation) was a serum creatinine figure. The lowest decline of creatinine in three weeks after the transplantation was noticed in the EC group (the average figure = 429 micro mol/l). In contrast the HTK group (the average figure 279 micro mol/l) and the UW group (the average figure 288 micro mol/l) had comparable figures and there was no significant difference between them from the statistical point of view. It means later in the first, the third and the fifth year after the transplantation the figures levelled out: EC 154 micro m/l, HTK 182 micro m/l, and UW 133 micro m/l. There was statistically a minimum significant difference between the HTK group and the UW group. Another criteria was to determine the amount of functional grafts in alive donees. The Assessment was carried out always in each year after the transplantation, altogether five years. The amount of the functional renal grafts in EC and HTK group was 100 %, in the UW group 76.9 %. CONCLUSION: HTK and UW gave better immediate functionality results, but there were no differences found among EC, HTK and the UW group from the long-term point of view.